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WHY CHOOSE US?
GO PAPERLESS
RESOURCES
COMMUNITIES WE SERVE
FAQS
HIGH RISK DRIVERS
MAKE A CLAIM
MANUAL QUOTE
QUICK LINKS
UNDERSTANDING DEMERIT POINTS
VIDEOS
CONTACT
Step
1
of
3
33%
ITEM #1 - Vehicle Ownership
Example:
Are you the current registered owner of the vehicle(s)?
*
(Note: We do not insure vehicles branded as 'rebuilt' or 'modified'.)
Yes
No
How many vehicles are to be insured under this policy?
*
Select ...
1
2
Vehicle #1: Attach a copy of the vehicle ownership.
*
Ensure to include both the Vehicle AND Plate portion as shown in the example above. JPG, GIF, PNG and PDF (max upload size 5MB)
Accepted file types: jpg, gif, png, pdf, Max. file size: 5 MB.
Vehicle #1: Provide 17-digit VIN#
*
(Example: 8956512121245A454)
Vehicle #1: Vehicle Make
*
(Example: Ford)
Vehicle #1: Vehicle Model
*
(Example: Mustang)
Vehicle #1: Vehicle Year
*
(Example: 2008)
Vehicle #2: Attach a copy of the vehicle ownership.
*
Ensure to include both the Vehicle AND Plate portion as shown in the example above. JPG, GIF, PNG and PDF (max upload size 5MB)
Accepted file types: jpg, gif, png, pdf, Max. file size: 5 MB.
Vehicle #2: Provide 17-digit VIN#
*
(Example: 8956512121245A454)
Vehicle #2: Vehicle Make
*
(Example: Ford)
Vehicle #2: Vehicle Model
*
(Example: Mustang)
Vehicle #2: Vehicle Year
*
(Example: 2008)
Hidden
Include Bill of Sale?
Hidden control field for bill of sale inclusion
ITEM #2 - Driver Information
Name
*
First
Last
Copy of Driver's License
*
Please scan and attach a copy of the FRONT of YOUR driver's license PDF, JPG, GIF, PNG (max upload size 5MB).
Accepted file types: pdf, jpg, jpeg, gif, png, Max. file size: 5 MB.
Email
*
Enter Email
Confirm Email
In addition to yourself, how many licensed drivers live in your household?
*
(If more than four, please contact our office directly)
None
One
Two
Three
Four
Does driver #1 have their own insurance coverage elsewhere?
*
Yes
No
Full Name
*
Driver's License #
*
Relationship
*
Spouse
Child
Family Member
Friend or Other
Insurance Company
*
Policy #
*
Copy of Driver's License
*
Please scan and attach a copy of the FRONT of Driver #1 license PDF, JPG, GIF, PNG (max upload size 5MB).
Accepted file types: pdf, jpg, jpeg, gif, png, Max. file size: 5 MB.
Does driver #2 have their own insurance coverage elsewhere?
*
Yes
No
Full Name
*
Driver's License #
*
Relationship
*
Spouse
Child
Family Member
Friend or Other
Insurance Company
*
Policy #
*
Copy of Driver's License
*
Please scan and attach a copy of the FRONT of Driver #2 license (PDF, JPG, GIF, PNG)
Accepted file types: pdf, jpg, jpeg, gif, png, Max. file size: 3 MB.
Does driver #3 have their own insurance coverage elsewhere?
*
Yes
No
Full Name
*
Driver's License #
*
Relationship
*
Spouse
Child
Family Member
Friend or Other
Insurance Company
*
Policy #
*
Copy of Driver's License
*
Please scan and attach a copy of the FRONT of Driver #3 license PDF, JPG, GIF, PNG format. (max upload size 5MB)
Accepted file types: pdf, jpg, jpeg, gif, png, Max. file size: 5 MB.
Does driver #4 have their own insurance coverage elsewhere?
*
Yes
No
Full Name
*
Driver's License
*
Relationship
*
Spouse
Child
Family Member
Friend or Other
Insurance Company
*
Policy #
*
Copy of Driver's License
*
Please scan and attach a copy of the FRONT of Driver #4 license PDF, JPG, GIF, PNG format. (max upload size 5MB)
Accepted file types: pdf, jpg, jpeg, gif, png, Max. file size: 5 MB.
ITEM #3 - Additional Information
When do you want policy to start?
*
MM slash DD slash YYYY
Is this vehicle leased or financed?
*
No
Yes
Leasing/Finance Company Details
*
Name of Company
Street Address
City
Province
Postal Code
Is there any un-repaired damage to the vehicle(s)?
*
Select ...
No
Yes
Attach a copy of the Bill of Sale/Lease Agreement
*
(PDF, JPG, GIF, PNG and max upload size 5MB)
Accepted file types: jpg, gif, png, pdf, Max. file size: 5 MB.
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